Construction and validation of the community health workers perception questionnaire on conditions amenable to physiotherapy in primary health care / Construção e validação do questionário de percepção dos Agentes Comunitários de Saúde sobre condições sensíveis à fisioterapia na Atenção Primária

Abstract Introduction Community health workers, like the physiotherapist, perform essential functions in primary health care, being an important element in the transformation of public policies. There are no reported studies investigating the knowledge of community health workers about health conditions amenable to physiotherapy intervention in primary health care. Objective To construct a questionnaire to investigate the perception of community health workers about health conditions that could be remedied by physiotherapy intervention in primary health care. Methods This was a methodological study in which it was initially an analysis matrix with the aim of encompassing the ideas contemplated in the questionnaire. To construct the instrument, a literature review was carried out, and health conditions treatable with physiotherapy in primary health care were chosen. To validate the content and appearance of the items, twelve physiotherapists specialized in primary health care judged the suitability of the items contained. The content validity index was used to determine the degree of agreement during the response analysis process. Subsequently, a semantic analysis was carried out through the understanding of the items by 15 community health workers. In the validation stage, two rounds of evaluation were carried out. Adjustments were made to 17 questions. Results The study investigated a questionnaire with 20 questions containing hypothetical situations of home visits, in which the resident's situation could or could not constitute a health risk amenable to physiotherapeutic intervention. Conclusion The community health workers perception instrument on health conditions amenable to physiotherapy intervention in primary health care proved to be valid for use in this context. The use of the instrument may contribute to the development of community health worker training programs, with the aim of facilitating team communication.

Resumo Introdução O Agente Comunitário de Saúde (ACS), assim como o fisioterapeuta, desencadeia funções fundamentais na Atenção Primária à Saúde (APS), sendo ele-mento importante na transformação de políticas públicas. Inexistem estudos que investiguem o conhecimento dos ACS sobre as condições de saúde sensíveis à inter-venção da fisioterapia na APS. Objetivo Construir um questionário de investigação da percepção dos ACS sobre as condições de saúde sensíveis à intervenção da fisioterapia na APS. Métodos Trata-se de um estudo metodológico no qual, inicialmente, construiu-se uma matriz de análise com o intuito de englobar as ideias contempladas no questionário. Para a construção do instrumento, realizou-se uma revisão da literatura, sendo eleitas condições de saúde sensíveis à intervenção da fisioterapia na APS. Para a validação de conteúdo e aparente dos itens, 12 fisioterapeutas especialistas em APS julgaram a adequação dos itens contidos. Utilizou-se o índice de validade de conteúdo para verificar o grau de concordância durante o processo de análise das respos-tas. Posteriormente, realizou-se análise semântica por meio da compreensão dos itens por 15 ACS. Na etapa de validação, foram realizadas duas rodadas de avaliação. Foram feitos ajustes em 17 questões. Resultados O estudo resultou em um questionário com 20 questões contendo situações hipotéticas de visitas domiciliares, cuja situação do morador poderia ou não configurar um risco à saúde sensível à intervenção fisioterapêutica. Conclusão O instrumento de percepção dos ACS sobre as condições de saúde sensíveis à intervenção da fisioterapia na APS mostrou-se válido para ser utilizado no contexto da APS. A utilização do instrumento poderá contribuir na elaboração de programas de capacitação dos ACS, com o intuito de facilitar a comunicação da equipe.

Análise da função respiratória em músicos instrumentistas de sopro / Analysis of the breathing function in wind instrumental musicians

Objetivo: realizar uma revisão integrativa a respeito da função pulmonar e da força muscular respiratória nos músicos de instrumentos de sopro. A relação da função respiratória com a utilização de instrumentos musicais de sopro é uma área do conhecimento ainda pouco explorada. Métodos: Realizada a revisão bibliográfica nas bases de dados MEDLINE, Embase, Cochrane, PeDro, BVS, Scopus, Web of Science e SciELO, através da combinação das palavras-chave "respiratory function test", "wind instrument", musician, "pulmonary ventilation" e "Lung Function Test". Resultados: Inicialmente foram encontrados 108 artigos, sendo que destes foram selecionados 11, totalizando 596 músicos instrumentistas de sopro, que fizeram parte dos grupos de estudo. Na maioria dos estudos os músicos apresentaram valores menores do volume expirado no primeiro segundo (VEF1) e da capacidade vital forçada (CVF) na espirometria que o grupo controle. No entanto, sem diferença quanto a relação VEF1/CVF. Assim como não há diferença na força muscular respiratória ou relação com doenças respiratórias. Conclusão: Os estudos atuais a respeito da consequência do instrumento de sopro em indivíduos não são capazes de evidenciar impactos positivos ou negativos na saúde respiratória desta população.

Objective: To conduct an integrative review of lung function and respiratory muscle strength in wind instrument musicians. The relationship between respiratory function and the use of wind musical instruments is an area of knowledge that has not been extensively explored. Methods: A bibliographic review was carried out in the MEDLINE, Embase, Cochrane, PeDro, BVS, Scopus, Web of Science, and SciELO databases by combining the keywords "respiratory function test", "wind instrument", musician, "pulmonary ventilation" and "Lung Function Test". Results: Initially, 108 articles were found, of which 11 were selected, totaling 596 wind instrumentalists who were part of the study groups. In most studies, musicians showed lower values of expired volume in one second (FEV1) and forced vital capacity (FVC) in spirometry than in the control group. However, there was no difference regarding the FEV1/FVC ratio, just as there was no difference in respiratory muscle strength or relationship with respiratory diseases. Conclusion: Current studies regarding the effect of wind instruments on individuals are unable to show positive or negative impacts on the respiratory health of this population.

Reliability and validity of specific quality of life assessment questionnaires related to chronic venous insufficiency: a systematic review / Confiabilidade e validade dos questionários específicos de avaliação da qualidade de vida relacionada à insuficiência venosa crônica: uma revisão sistemática

Abstract This systematic review aimed to discuss the main findings regarding the reliability and validity of health-related quality of life questionnaires for chronic venous insufficiency. Searches were performed on the MEDLINE, CINAHL, Web of Science, LILACS, and Scopus databases. The search terms used were related to "venous insufficiency", and "quality of life". The CIVIQ-20 and CIVIQ-14 instruments had adequate internal consistency and both were able to discriminate disease severity. The VEINES-QoL showed adequate internal consistency but was not able to discriminate disease severity. Most studies did not demonstrate a correlation between VEINES-QoL and the mental component of the SF-36. The AVVQ had inadequate reliability but its validity was also doubtful when compared to the SF-36. The VARIShort demonstrated good internal consistency, reproducibility, and validity, but only the original study was included. For venous leg ulcers, the CCVUQ showed adequate reliability and validity when compared to VLU-QoL.

Resumo Esta revisão sistemática objetivou discutir os principais achados sobre a confiabilidade e validade dos questionários de qualidade de vida relacionada à saúde na insuficiência venosa crônica. A busca foi realizada nas bases de dados MEDLINE, CINAHL, Web of Science, LILACS e Scopus. Os termos de busca foram relacionados a "insuficiência venosa" e "qualidade de vida". O Chronic Lower Limb Venous Insufficiency Questionnaire (CIVIQ)-20 e o CIVIQ-14 apresentaram consistência interna adequada e foram capazes de discriminar a gravidade da doença. O Venous Insufficiency Epidemiological and Economic Study - Quality of Life (VEINES-QoL) apresentou consistência interna adequada, mas não foi capaz de discriminar a gravidade da doença. A maioria dos estudos não demonstrou associação do VEINES-QoL com o componente mental do Short Form Health Survey (SF-36). O Aberdeen Varicose Vein Questionnaire (AVVQ) apresentou confiabilidade inadequada e validade duvidosa quando comparado ao SF-36. O VARIShort demonstrou consistência interna, reprodutibilidade e validade boas, mas apenas o estudo original foi incluído. Na úlcera venosa, o Charing Cross Venous Ulcer Questionnaire (CCVUQ) apresentou confiabilidade e validade adequadas quando comparado ao Venous Leg Ulcer Quality of Life (VLU-QoL).

The health-related quality of life in patients with post-COVID-19 after hospitalization: a systematic review

ABSTRACT Symptoms in post-COVID-19 patients who require hospitalization can persist for months, significantly affecting their health-related quality of life (HRQoL). Thus, the present study aimed to discuss the main findings regarding HRQoL in post-COVID-19 patients who required hospitalization. An electronic search was performed in the MEDLINE, EMBASE, CINAHL, Web of Science, LILACS, and Scopus databases, without date and language restrictions, until July 2021. Twenty-four articles were included in the analysis. It seems that HRQoL partially improved soon after hospital discharge, although the negative impact on HRQoL may persist for months. The physical and mental aspects are affected because patients report pain, discomfort, anxiety, and depression. The HRQoL of COVID-19 infected patients was worse than that of uninfected patients. Additionally, HRQoL seemed worse in patients admitted to the intensive care unit than in those who remained in the ward. Improvements in HRQoL after hospital discharge are independent of imaging improvement, and there seems to be no association between HRQoL after hospital discharge and disease severity on hospital admission. Many factors have been identified as determinants of HRQoL, with women and advanced age being the most related to worse HRQOL, followed by the duration of invasive mechanical ventilation and the need for intensive care. Other factors included the presence and number of comorbidities, lower forced vital capacity, high body mass index, smoking history, undergraduate education, and unemployment. In conclusion, these findings may aid in clinical management and should be considered in the aftercare of patients.

The health-related quality of life in patients with Chagas disease: the state of the art

ABSTRACT Chagas disease (CD) is a neglected tropical disease associated with poverty in which patients are surrounded by stigma. These factors can contribute to reducing health-related quality of life (HRQoL). Therefore, a broad discussion of HRQoL in the CD population is required. This study aimed to discuss the main findings of HRQoL in patients with CD, focusing on the association between sociodemographic and lifestyle factors, echocardiographic and functional determinants, and the effect of non-invasive interventions on HRQoL. A literature search of the MEDLINE, Web of Science, CINAHL, Scopus, and LILACS databases was performed with no data or language restrictions. Twenty-two articles were included in this meta-analysis. In general, HRQoL is worse in patients with CD than in healthy individuals, particularly in the presence of cardiovascular and/or gastrointestinal symptoms. Sex, age, functional class, level of physical activity, healthy habits, and medications received could affect HRQoL. Among the echocardiographic and functional determinants, decreased systolic function seems to negatively affect HRQoL. No association with the peak oxygen uptake was observed in the maximal tests. By contrast, well-tolerated field tests with submaximal intensities were associated with HRQoL. Both pharmaceutical care and exercise training have a positive effect on the HRQoL of patients with Chagas cardiomyopathy, and the mental component can be a prognostic marker in this population. In conclusion, assessment of HRQoL can provide important information about the health status of patients with CD, and its use in clinical practice is warranted.

Health-Related Quality of Life Reported by Patients With Chagas Disease: A Systematic Review of Qualitative Evidence With GRADE Recommendations

ABSTRACT Patients with Chagas disease have reduced health-related quality of life (HRQoL). Hence, we aimed to identify the factors that mostly affected their HRQoL. This was a systematic review of qualitative studies. The Latin American and Caribbean Health Sciences Literature, Medical Literature Analysis and Retrieval System Online, Excerpta Medica Database, Web of Science, and SciVerse Scopus databases were searched for relevant studies without language or date restrictions. The search and data analysis were performed by independent reviewers; all qualitative studies that reported the factors that had an impact on the HRQoL of patients with Chagas disease were included. The risk of bias was assessed using the Critical Appraisal Skills Program Qualitative Study Checklist; confidence in the evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative approach. Five studies were included in this review: four in Brazil and one in California, United States, with immigrants from Central and South America. The sample consisted of 207 patients with chronic Chagas disease. Stigma, physical limitations, work absenteeism, emotional or mental aspects, fear of treatment, and fear of the future had the strongest impact on the HRQoL. All items showed moderate confidence except for fear of treatment (low confidence). The physical, emotional, mental, and cultural aspects affected the HRQoL of patients with chronic Chagas disease. Identification of these factors is important in the development of strategies aimed at improving the HRQoL of this population.

Determinantes da capacidade funcional em pacientes com doença de chagas / Determinants of functional capacity in patients with chagas disease

Resumo Fundamento: A doença de Chagas leva à redução da capacidade funcional. Entretanto, o estágio em que o comprometimento funcional é detectável permanece obscuro. Objetivos: O presente estudo teve como objetivo comparar a capacidade funcional de pacientes em diferentes estágios da doença de Chagas e de indivíduos saudáveis e verificar os determinantes do consumo de oxigênio de pico (VO2pico). Métodos: Em um estudo transversal, foram selecionados 160 indivíduos, 35 saudáveis e 125 com doença de Chagas. No grupo chagásico, 61 (49%) estavam na forma indeterminada da doença, 45 (36%) com cardiomiopatia chagásica (CC) e função cardíaca preservada e 19 (15%) com disfunção cardíaca e CC dilatada. Os dados foram analisados por meio de análise de regressão univariada e multivariada. A significância estatística foi fixada em 5%. Resultados: Pacientes na forma indeterminada da doença apresentaram capacidade funcional semelhante a indivíduos saudáveis (p> 0,05). Pacientes com ChC e função cardíaca preservada apresentaram VO2pico menor que os pacientes na forma indeterminada (p <0,05), mas apresentaram valores de VO2pico semelhantes ao ChC dilatado (p = 0,46). A idade, sexo masculino, classe funcional da NYHA, pressão arterial diastólica, razão entre a velocidade do fluxo transmitral diastólico precoce e a velocidade anular mitral diastólica precoce, a fração de ejeção do ventrículo esquerdo (FEVE) e o diâmetro diastólico final do ventrículo esquerdo foram associados à capacidade funcional. Porém, apenas idade, sexo masculino, FEVE e classe funcional da NYHA permaneceram associados ao VO2pico no modelo final (R2 ajustado = 0,60). Conclusão: Pacientes com CC apresentam menor capacidade funcional do que pacientes na forma indeterminada. FEVE, idade, sexo masculino e classe funcional da NYHA foram determinantes do VO2pico em pacientes com doença de Chagas.

Abstract Background: Chagas disease leads to reduced functional capacity. However, the stage at which functional impairment is detectable remains unclear. Objectives: The present study was addressed to compare the functional capacity of patients at different stages of Chagas disease and healthy individuals and to verify the determinants of peak oxygen uptake (VO2peak). Methods: In a cross-sectional study, 160 individuals were selected, 35 healthy and 125 with Chagas disease. In the Chagasic group, 61 (49%) were in the indeterminate form of the disease, 45 (36%) with Chagas cardiomyopathy (ChC) and preserved cardiac function and 19 (15%) with cardiac dysfunction and dilated ChC. The data were analyzed using univariate and multivariate regression analysis. Statistical significance was set at 5%. Results: Patients in the indeterminate form of disease showed similar functional capacity to healthy individuals (p>0.05). Patients with ChC and preserved cardiac function had lower VO2peak than patients in the indeterminate form (p<0.05), but showed similar VO2peak values than dilated ChC (p=0.46). The age, male sex, NYHA functional class, diastolic blood pressure, ratio of the early diastolic transmitral flow velocity to early diastolic mitral annular velocity, left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter were associated with functional capacity. However, only age, male sex, LVEF and NYHA functional class, remained associated with VO2peak in the final model (adjusted R2=0.60). Conclusion: Patients with ChC had lower functional capacity than patients in the indeterminate form. LVEF, age, male sex and NYHA functional class were determinants with VO2peak in patients with Chagas disease.

Determinants of minute ventilation-carbon dioxide production relationship in Chagas cardiomyopathy

Abstract INTRODUCTION: The minute ventilation-carbon dioxide production relationship (VE/VCO2 slope) is among the main prognostic factors of Chagas cardiomyopathy whose determinants remain unknown. METHODS: Seventy-eight patients with Chagas cardiomyopathy were evaluated using clinical assessment, cardiopulmonary exercise test, echocardiography, and International Physical Activity Questionnaire. RESULTS: Age, functional class, International Physical Activity Questionnaire score, and dilated cardiomyopathy with systolic dysfunction were independent determinants of VE/VCO2 slope, and these variables explained 63% of its variance. CONCLUSIONS: The VE/VCO2 slope was related to age, functional class, physical activity level, and dilated cardiomyopathy with systolic dysfunction in patients with Chagas cardiomyopathy.

Functional capacity and rehabilitation strategies in Covid-19 patients: current knowledge and challenges

Abstract Covid-19 is a novel infectious disease whose spectrum of presentation ranges from absence of symptoms to widespread interstitial pneumonia associated with severe acute respiratory syndrome (SARS), leading to significant mortality. Given the systemic pattern of Covid-19, there are many factors that can influence patient's functional capacity after acute infection and the identification of such factors can contribute to the development of specific rehabilitation strategies. Pulmonary impairment is the primary cause of hospitalization due to Covid-19, and can progress to SARS as well as increase length of hospitalization. Moreover, cardiac involvement is observed in approximately 30% of hospitalized patients, with an increased risk of acute myocarditis, myocardial injury, and heart failure, which may compromise functional capacity in the long-term. Thromboembolic complications have also been reported in some patients with Covid-19 and are associated with a poor prognosis. Musculoskeletal complications may result from long periods of hospitalization and immobility, and can include fatigue, muscle weakness and polyneuropathy. Studies that address the functional capacity of patients after Covid-19 infection are still scarce. However, based on knowledge from the multiple systemic complications associated with Covid-19, it is reasonable to suggest that most patients, especially those who underwent prolonged hospitalization, will need a multiprofessional rehabilitation program. Further studies are needed to evaluate the functional impact and the rehabilitation strategies for patients affected by Covid-19.

Tradução, adaptação transcultural e confiabilidade da escala de utilidade clínica de Tyson e Connell / Traducción, adaptación intercultural y fiabilidad de la escala de utilidad clínica de Tyson y Connell / Translation, cross-cultural adaptation and reliability of the clinical utility scale of Tyson and Connell

RESUMO O objetivo deste estudo foi traduzir e adaptar a escala de utilidade clínica de Tyson e Connell para o português brasileiro, além de avaliar sua confiabilidade interexaminador e intraexaminador. O processo de tradução e adaptação transcultural foi desenvolvido em cinco estágios: tradução; síntese das traduções; retrotradução; avaliação pelo comitê de especialistas; e teste da versão pré-final. Para avaliação da confiabilidade intra e interexaminador da escala, 20 instrumentos de avaliação foram analisados de forma independente por dois examinadores (confiabilidade interexaminador). Além disso, um dos examinadores fez todas as avaliações, em dois momentos distintos, com um intervalo de 30 dias entre uma e outra (confiabilidade intraexaminador). A tradução e a adaptação transcultural foram realizadas de forma sistemática, seguindo os critérios propostos, de modo que houve apenas pequenas alterações em dois itens para tornar a escala mais útil a todos os instrumentos disponíveis na literatura. Em relação à confiabilidade interexaminador da escala de utilidade clínica de Tyson e Connell-Brasil, o valor encontrado foi CCI=0,85 (IC 95%, 0,79-0,87), enquanto para a confiabilidade intraexaminador o resultado foi CCI=0,89 (IC 95%, 0,85-0,93). Os resultados deste processo indicaram adequado grau de equivalência semântica, conceitual e cultural. Além disso, as medidas de confiabilidade intra e interexaminadores foram consideradas adequadas. Esses achados demonstraram que a escala é adequada para avaliar a utilidade clínica de instrumentos de avaliação comumente utilizados em pacientes. Dessa forma, deve ser incorporada na prática clínica e em pesquisas para a escolha do melhor instrumento.

RESUMEN O objetivo deste estudo foi traduzir e adaptar a escala de utilidade clínica de Tyson e Connell para o português brasileiro, além de avaliar sua confiabilidade interexaminador e intraexaminador. O processo de tradução e adaptação transcultural foi desenvolvido em cinco estágios: tradução; síntese das traduções; retrotradução; avaliação pelo comitê de especialistas; e teste da versão pré-final. Para avaliação da confiabilidade intra e interexaminador da escala, 20 instrumentos de avaliação foram analisados de forma independente por dois examinadores (confiabilidade interexaminador). Além disso, um dos examinadores fez todas as avaliações, em dois momentos distintos, com um intervalo de 30 dias entre uma e outra (confiabilidade intraexaminador). A tradução e a adaptação transcultural foram realizadas de forma sistemática, seguindo os critérios propostos, de modo que houve apenas pequenas alterações em dois itens para tornar a escala mais útil a todos os instrumentos disponíveis na literatura. Em relação à confiabilidade interexaminador da escala de utilidade clínica de Tyson e Connell-Brasil, o valor encontrado foi CCI=0,85 (IC 95%, 0,79-0,87), enquanto para a confiabilidade intraexaminador o resultado foi CCI=0,89 (IC 95%, 0,85-0,93). Os resultados deste processo indicaram adequado grau de equivalência semântica, conceitual e cultural. Além disso, as medidas de confiabilidade intra e interexaminadores foram consideradas adequadas. Esses achados demonstraram que a escala é adequada para avaliar a utilidade clínica de instrumentos de avaliação comumente utilizados em pacientes. Dessa forma, deve ser incorporada na prática clínica e em pesquisas para a escolha do melhor instrumento.

ABSTRACT This study aimed to translate and adapt the Clinical Utility Scale of Tyson and Connell into Brazilian Portuguese, in addition to evaluating intra- and inter-rater reliability. The process of cross-cultural translation and adaptation was developed in five stages: translation, synthesis of translations, retro translation, evaluation by the committee of experts and testing of the pre-final version. To evaluate the intra- and inter-rater reliability of the Clinical Utility Scale of Tyson and Connell, 20 assessment instruments were independently assessed by two examiners (inter-rater reliability). In addition, one of the examiners performed all assessments at two different times with a 30-day interval (intra-rater reliability). The translation and cross-cultural adaptation were performed in a systematic way, following the proposed criteria, and only minor changes in two items were necessary to make the scale more useful to all instruments currently available in the literature. Regarding the inter-rater reliability of the Clinical Utility Scale of Tyson and Connell, the value found was ICC=0.85 (IC 95%, 0,79-0,87), while for intra-rater reliability the result was ICC=0,89 (IC 95%, 0,85-0,93). The results of this process indicated an adequate degree of semantic, conceptual and cultural equivalence. In addition, intra- and inter-rater reliability measures were considered adequate. These findings have shown the scale is adequate to assess the clinical utility of evaluation instruments usually applied to patients. Therefore, it must be incorporated into clinical practice and research when choosing the best evaluation instrument to be used.

Exercise tests in Chagas cardiomyopathy: an overview of functional evaluation, prognostic significance, and current challenges

Abstract Patients with Chagas cardiomyopathy (ChC) usually progress with fatigue and dyspnea. Exercise tests are valuable for the functional evaluation of these patients. However, information about the applicability of the exercise tests is scattered, and no studies have systematically reviewed the results. Thus, the present review explored the general aspects and prognostic value of exercise tests in patients with ChC. A literature search of the MEDLINE, Web of Science, CINAHL, Scopus, and LILACS databases was performed to identify relevant studies. There were no data restrictions, and articles that met the objective of the study were selected. Articles written in English, Portuguese, and Spanish were considered, and 25 articles were finally included. The peak oxygen uptake (VO2peak) was correlated with demographic and echocardiographic variables. Echocardiographic features of the left ventricular diastolic function and right ventricular systolic function appeared to be determinants of functional capacity, in addition to age and sex. VO2peak was associated with higher mortality, especially in patients with dilated ChC. The minute ventilation/carbon dioxide production slope (VE/VCO2 slope) was a strong predictor of survival; however, more studies are needed to verify this observation. Field tests showed moderate to strong correlation with VO2peak and thus may be inexpensive tools for the functional evaluation of patients with ChC. However, few studies have verified their prognostic significance. While exercise tests are useful tools for functional assessment, information is scarce regarding further considerations, and many of the criteria are based on guidelines for other heart diseases.

Prevalence and determinants of depressive symptoms in patients with Chagas cardiomyopathy and predominantly preserved cardiac function

Abstract INTRODUCTION: Chagas cardiomyopathy (ChC) is highly stigmatized, and the presence of depressive symptoms may be a common feature. However, its determinants remain unclear. Therefore, the present study aimed to verify the prevalence of depression and the clinical, echocardiographic, functional, and quality of life factors associated with depressive symptoms in patients with ChC and predominantly preserved cardiac function. METHODS: Thirty-five patients with ChC (aged 40 to 60 years, 66% men, NYHA I-III) were evaluated by echocardiography, cardiopulmonary exercise testing, 6-minute walk test (6MWT), and Mini-Mental State Examination. Physical activity level was assessed using the Human Activity Profile (HAP) and health-related quality of life was assessed using the Short-Form Health Survey (SF-36). Depressive symptoms were evaluated using the Beck Depression Inventory. A cutoff point greater than 9 was indicative of depression. RESULTS: Depression was detected in 13 patients (37%). In the univariate analysis, female sex, NYHA functional class, body mass index, HAP score, mental summary of SF-36, peak oxygen uptake, and 6MWT distance were associated with depressive symptoms. The final model showed that only the HAP score (B = -0.533; 95% confidence interval [CI]: -0.804 to -0.262) and SF-36 mental summary (B = -0.269; 95% CI: -0.386 to -0.153) remained as independent predictors of depressive symptoms in patients with ChC. CONCLUSIONS: Depression was prevalent in patients with ChC and predominantly preserved cardiac function. Physical activity and mental health were independent risk factors for depressive symptoms.

Efeitos do fortalecimento muscular do assoalho pélvico em pacientes pós-acidente vascular encefálico com incontinência urinária / Effects of pelvic floor muscle strengthening in post-stroke patients with urinary incontinence

Introdução: Pacientes pós-acidente vascular encefálico (AVE) apresentam alterações motoras, causando perda de força muscular, que afeta inclusive os músculos do assoalho pélvico. Essa perda de força pode levar a incontinência urinária que consiste na perda involuntária de urina. A Sociedade Internacional de Incontinência Urinária (SIC) indicou a fisioterapia como tratamento de primeira linha para a incontinência urinária, mas ainda não foram encontradas revisões sistemáticas da literatura que avalie o efeito do fortalecimento muscular do assoalho pélvico em pacientes pós-AVE com IU. Objetivo: Realizar uma revisão sistemática da literatura sobre os efeitos do fortalecimento do assoalho pélvico em pacientes pós-AVE com IU. Métodos: Buscas nas bases Medline, Lilacs, Scielo, PEDro, sem restrição de data ou idioma de publicação. Foram utilizadas combinações de palavras-chave, tais como: acidente vascular encefálico, reabilitação, incontinência urinária, fisioterapia, assoalho pélvico, além de seus respectivos termos em inglês. Os estudos foram analisados por dois avaliadores independentes. A qualidade metodológica dos estudos incluídos foi avaliada de acordo com a escala PEDro. Resultados: A estratégia de busca resultou em 693 artigos, e após a análise de títulos, resumos e textos completos, realizados por dois avaliadores independentes, foram excluídos 688, restando cinco artigos selecionados para a presente revisão sistemática. Em geral, os estudos mostraram que os pacientes pós-AVE obtiveram melhora em todas as medidas de desfecho investigadas (força, resistência e atividade dos músculos do assoalho pélvico, frequência de micção, número de episódios de incontinência, número de absorventes usados, quantidade da perda de urina, função do trato urinário inferior, sintomas da bexiga hiperativa e independência funcional), exceto na qualidade de vida e impacto da incontinência, tanto a curto como a longo prazo. Conclusão: Os resultados parecem promissores em relação à eficácia do fortalecimento muscular do assoalho pélvico como uma intervenção para a reabilitação de indivíduos com IU pós-AVE. No entanto, tais conclusões se baseiam em apenas cinco estudos, de qualidade metodológica moderada, necessitando de mais estudos sobre o assunto. (AU)

Introduction: Post-stroke patients present motor impairments, such as muscle weakness, which also affects the pelvic floor muscles. This loss of strength can lead to urinary incontinence (UI), which consists of involuntary loss of urine. The International Society for Urinary Incontinence has indicated physical therapy as a first-line treatment for UI, but no systematic reviews of the literature have yet found that evaluates the effects of pelvic floor muscle training in post-stroke patients with UI. Objective: To perform a systematic review of the literature investigating the effects of pelvic floor strengthening in post-stroke patients with UI. Methods: Searches in Medline, Lilacs, Scielo, PEDro, without restriction of date or language of publication were performed. The terms included the following descriptors: stroke, rehabilitation, urinary incontinence, physical therapy, pelvic floor, as well as these terms in Portuguese, with strategies specific to each base. The studies were analyzed by two independent evaluators. The methodological quality of the included studies was evaluated according to the PEDro scale. Results: The search strategy resulted in 693 articles, and after the analysis of titles, abstracts and full texts, 688 were excluded, resulting in five articles selected for the present systematic review. In general, studies have shown that post-stroke patients improved all investigated outcome measures (strength, endurance and pelvic floor muscle activity, urinary frequency, number of incontinence episodes, number of absorbents used, amount of loss of urine, lower urinary tract function, overactive bladder symptoms and functional independence), except for the quality of life and impact of incontinence, both short-term and long-term. Conclusion: As observed, the results seem promising regarding the efficacy of pelvic floor muscle training as an intervention for the rehabilitation of individuals with UI post-stroke. However, these conclusions are based on only five studies, of moderate methodological quality, requiring further studies. (AU)

Reduced functional capacity in patients with Chagas disease: a systematic review with meta-analysis

Abstract Reduced peak oxygen uptake (VO2peak) is a common clinical finding in progressive Chagas disease. However, the disease stage in which functional impairment is detectable remains uncertain. The present study compared functional capacity between healthy controls and patients with different clinical forms of Chagas disease. A systematic review and meta-analysis (PROSPERO database CRD42017058353) was conducted following a search of the MEDLINE, Web of Science, CINAHL, and LILACS databases from September to December 2017 for articles published in English, Spanish, or Portuguese, with no date restrictions. We included studies that compared the VO2peak between healthy and Chagas disease patients, stratified according to 3 clinical forms [no apparent cardiac disease, non-dilated Chagas heart disease (CHD), and dilated CHD]. Seven cross-sectional studies were included. Chagas disease patients without apparent cardiac disease (n=208) had VO2peak values [mean difference, -1.55ml/kg/min; 95% confidence interval (CI), -4.98ml/kg/min to 1.88ml/kg/min] similar to those of healthy controls (n=105; p=0.38, I2=52%). In non-dilated CHD (n=159), VO2peak was 8.71ml/kg/min lower (95% CI, -13.99 to -3.42ml/kg/min) than in healthy controls (n=59; p=0.001, I2=75%). VO2peak was also significantly lower (mean difference, -9.30ml/kg/min; 95% CI, -11.34 to -7.25ml/kg/min) in dilated CHD patients (n=131) than in healthy controls (n=53; p<0.001, I2=0%). Exercise capacity in Chagas disease patients without apparent cardiac disease is similar to that in healthy controls. Functional impairment in Chagas disease is detectable in the early stages of cardiac involvement, even in the absence of systolic dysfunction and signs of heart failure.

Efeitos de programas de reabilitação multidisciplinar no tratamento de pacientes com doença de Alzheimer: uma revisão sistemática / Effects of multidisciplinary rehabilitation programs on treatment of patients with Alzheimer's disease: a systematic review

Resumo Introdução A Doença de Alzheimer (DA) é caracterizada por perda das funções cognitivas de forma progressiva, como falhas na memória, aprendizagem e linguagem, que tendem a se agravar com o avanço da doença. As ações multidisciplinares no paciente com DA têm como objetivo interferir positivamente no processo saúde-doença, por meio de uma abordagem integral aos indivíduos e familiares, intervindo com ações voltadas à realidade na qual estão inseridos. Objetivo Realizar uma revisão sistemática sobre os efeitos da reabilitação multidisciplinar em pacientes com Doença de Alzheimer (DA). Método Foram realizadas buscas nas bases MEDLINE, LILACS, PEDro, CINAHL e Web of Science , sem restrição de data ou de idioma de publicação. Os artigos foram avaliados pelo título, pelo resumo e, posteriormente, pelo texto completo, por dois autores independentes. A qualidade metodológica dos estudos experimentais selecionados foi avaliada de acordo com a escala PEDro. Resultados Foram incluídos cinco estudos, de qualidade metodológica moderada (5,4 na escala PEDro), que evidenciaram que um programa multidisciplinar pode ser eficaz no tratamento de pacientes com DA, com melhoras significativas, principalmente, em sintomas neuropsiquiátricos, depressão e qualidade de vida. Para as demais medidas de desfecho investigadas, devido à presença de poucos estudos que encontraram efeitos positivos (nível de estresse, ansiedade, independência, atividades) ou de resultados conflitantes (cognição), não é possível determinar a eficácia dessa intervenção. Conclusão Esta revisão sistemática evidenciou que um programa multidisciplinar pode ser eficaz no tratamento de pacientes com DA, com melhoras significativas, principalmente, em sintomas neuropsiquiátricos, depressão e qualidade de vida. No entanto, os resultados para cognição, nível de ansiedade, estresse, independência e realização de atividades não foram significativos ou foram conflitantes.

Abstract Background Alzheimer's Disease (AD) is characterized by a progressive loss of cognitive functions, such as memory, learning and language deficits, which tend to be aggravated by the progression of the disease. Multidisciplinary actions in the patient with AD aim to positively interfere in the health-disease process, through an integral approach to individuals and families, intervening with actions focused on the reality in which they are inserted. Objective Conduct a systematic review of the literature investigating the effects of multidisciplinary rehabilitation programs on patients with Alzheimer's disease (AD). Method A searches was conducted in the Medline, LILACS, Scielo, PEDro, and CINAHL databases with no restriction regarding language and year of publication. The articles were evaluated by title, abstract, and full text and, finally selected according to eligibility by two independent authors. The methodological quality of the experimental studies was evaluated using the PEDro scale. Results Five studies of moderate methodological quality were included in the present systematic review. Results showed that multidisciplinary programs may be effective in the treatment of AD patients, with significant improvements mainly in neuropsychiatric symptoms, depression, and quality of life. For the other outcome measures investigated, because few studies with positive effects (stress level, anxiety, autonomy, and activity) or conflicting results (cognition) were found, it was not possible to determine the effectiveness of this intervention. Conclusion This systematic review has shown that multidisciplinary programs can be effective in the treatment of patients with AD, with significant improvements mainly in neuropsychiatric symptoms, depression, and quality of life; however, results regarding cognition, levels of anxiety and stress, autonomy, and performance of activities were neither significant nor conflicting.

Exercise-induced ventricular arrhythmias and vagal dysfunction in Chagas disease patients with no apparent cardiac involvement

INTRODUCTION : Exercise-induced ventricular arrhythmia (EIVA) and autonomic imbalance are considered as early markers of heart disease in Chagas disease (ChD) patients. The objective of the present study was to verify the differences in the occurrence of EIVA and autonomic maneuver indexes between healthy individuals and ChD patients with no apparent cardiac involvement. METHODS : A total of 75 ChD patients with no apparent cardiac involvement, aged 44.7 (8.5) years, and 38 healthy individuals, aged 44.0 (9.2) years, were evaluated using echocardiography, symptom-limited treadmill exercise testing and autonomic function tests. RESULTS : The occurrence of EIVA was higher in the chagasic group (48%) than in the control group (23.7%) during both the effort and the recovery phases. Frequent ventricular contractions occurred only in the patient group. Additionally, the respiratory sinus arrhythmia index was significantly lower in the chagasic individuals compared with the control group. CONCLUSIONS : ChD patients with no apparent cardiac involvement had a higher frequency of EIVA as well as more vagal dysfunction by respiratory sinus arrhythmia. These results suggest that even when asymptomatic, ChD patients possess important arrhythmogenic substrates and subclinical disease. .

Health-related quality of life in patients with Chagas disease: a review of the evidence

Chagas disease (ChD), a neglected tropical disease caused by infection with the parasite Trypanosoma cruzi (T. cruzi), remains a serious public health issue in Latin America and is an emerging disease in several non-endemic countries, where knowledge of the condition and experience with its clinical management are limited. Regionally, the disease is the major cause of disability secondary to tropical diseases in young adults. Health-related quality of life (HRQoL) impairment is common in patients with ChD, especially in those with Chagas dilated cardiomyopathy, the most severe manifestation of the disease, which frequently leads to heart failure. The aim of this review was to conduct a literature search for studies that have evaluated the determining factors of HRQoL in ChD patients. We included cross-sectional, case-control, cohort, and experimental studies, as well as clinical trials that evaluated the HRQoL in ChD patients aged 18 to 60 years and are presenting an explicit description of statistical analysis. Using a combination of keywords based on Descriptors in Health Sciences (DeCS) and Medical Subject Headings (MeSH) for searches in PubMed and the Scientific Electronic Library Online (SciELO), 148 studies were found. After exclusions, 12 studies were selected for analysis. Three main findings were extracted from these studies: 1) cardiac involvement is associated with a worse HRQoL in ChD patients; 2) HRQoL is associated with the patients' functional capacity; and 3) simple and inexpensive therapeutic measures are effective for improving HRQoL in ChD patients. Hence, ChD patients' functional capacity, the effectiveness of non-surgical conservative treatment, and cardiac involvement are important determining factors for the HRQoL in ChD patients.

Relação entre a fração de ejeção do ventrículo esquerdo e razão e/e' com a capacidade funcional na cardiopatia chagásica / Relationship between left ventricular ejection fraction and e /e' ratiowith functional capacity in chagas heart disease

Introdução: disfunção ventricular e capacidade funcional são importantes marcadores de morbimortalidade na cardiopatia chagásica (CCh). Objetivos: verificar a associação entre a capacidade funcional e funções sistólica e diastólica do ventrículo esquerdo na CCh. Metodologia: foram submetidos 35 pacientes com CCh (47,11±8,15 anos) a avaliação clínica, ecocardiograma e teste de esforço cardiopulmonar (TECP), sendo classificados em dois grupos: dilatado (com cardiomiopatia dilatada) e não dilatado (função sistólica preservada). Foram consideradas as variáveis fração de ejeção do ventrículo esquerdo (FEVE), razão E/e' e o pico do consumo de oxigênio (VO2pico). Na análise estatística foram realizados os testes de Pearson ou Spearman e a análise de regressão linear múltipla avaliou o efeito da FEVE e E/e' no VO2pico. Resultados: na amostra total houve correlação significativa entre o VO2pico e a FEVE (r=0,536, p=0,001) e correlação negativa e significativa entre o VO2pico e razão E/e' (r=-0,399; p=0,022). No grupo dilatado (n=16), correlação significativa foi observada entre o VO2pico com a FEVE (r=0,611, p=0,016) e a razão E/e' (r=-0,601, p=0,018). A análise multivariada das variáveis identificou a FEVE e a razão E/e' como fortes preditores do VO2pico (r=0,850; r2 =0,723).Não houve correlação significativa entre o VO2pico e a FEVE (r=0,393, p=0,107) e a razão E/e' (r=0,102, p=0,687) no grupo não dilatado (n=19). Conclusão: a capacidade funcional avaliada pelo VO2pico relaciona-se à função sistólica e diastólica em pacientes com cardiomiopatia dilatada chagásica.

Background: Left ventricular dysfunction and functional capacity (FC) are important markers of morbidity and mortality in Chagas heart disease (CHD), however, the relationship between these clinical parameters remains controversial. Objective: To verify the association between FC and systolic and diastolic functions of the left ventricle in CHD patients. Methods: Thirty-five CHD patients (47.11±8.15 years) underwent clinical evaluation, echocardiography and Cardiopulmonary Exercise Testing (CPET) and were classified into two groups: dilated group (dilated cardiomyopathy) and non-dilated group (preserved systolic function). The left ventricular ejection fraction (LVEF), E/e' ratio and peak oxygenuptake (VO2peak)were considered. Statistical analysis was carried outwith Pearson or Spearman correlation tests and backward multivariate linear regression analysis was performed to assess the effect of LVEF and E/e' ratio on VO2peak. Results: In the overall study population, there was a significant correlation between VO2peak and LVEF (r=0.536; p=0.001) and a significant negative correlation between VO2peak and E/e' ratio (r=-0.399;p=0.022). In the dilated group (n=16), a significant correlation was also observed between VO2peak and both LVEF(r=0.611; p=0.016) and E/e' ratio (r=-0.601; p=0.018). The multivariate analysis of these variables identified the LVEF and E/e' ratio as strong predictors of VO2peak (r=0.850; r2=0.723). In contrast, in the non-dilated group (n=19), there was no significant correlation between VO- 2peak and LVEF (r=0.393; p=0.107) and E/e' ratio (r=0.102; p=0.687). Conclusion: Functional capacity assessed by VO2peak was related to systolic and diastolic function in CHD patients with dilated cardiomyopathy.

Effects of Exercise Training on Heart Rate Variability in Chagas Heart Disease / Efeitos do Treinamento Físico sobre a Variabilidade da Frequência Cardíaca na Cardiopatia Chagásica

Background: Heart rate variability (HRV) is a marker of autonomic dysfunction severity. The effects of physical training on HRV indexes in Chagas heart disease (CHD) are not well established. Objective: To evaluate the changes in HRV indexes in response to physical training in CHD. Methods: Patients with CHD and left ventricular (LV) dysfunction, physically inactive, were randomized either to the intervention (IG, N = 18) or control group (CG, N = 19). The IG participated in a 12-week exercise program consisting of 3 sessions/week. Results: Mean age was 49.5 ± 8 years, 59% males, mean LVEF was 36.3 ± 7.8%. Baseline HRV indexes were similar between groups. From baseline to follow-up, total power (TP): 1653 (IQ 625 - 3418) to 2794 (1617 - 4452) ms, p = 0.02) and very low frequency power: 586 (290 - 1565) to 815 (610 - 1425) ms, p = 0.047) increased in the IG, but not in the CG. The delta (post - pre) HRV indexes were similar: SDNN 11.5 ± 30.0 vs. 3.7 ± 25.1 ms. p = 0.10; rMSSD 2 (6 - 17) vs. 1 (21 - 9) ms. p = 0.43; TP 943 (731 - 3130) vs. 1780 (921 - 2743) Hz. p = 0.46; low frequency power (LFP) 1.0 (150 - 197) vs. 60 (111 - 146) Hz. p = 0.85; except for high frequency power, which tended to increase in the IG: 42 (133 - 92) vs. 79 (61 - 328) Hz. p = 0.08). Conclusion: In the studied population, the variation of HRV indexes was similar between the active and inactive groups. Clinical improvement with physical activity seems to be independent from autonomic dysfunction markers in CHD. .

Fundamento: A variabilidade da frequência cardíaca (VFC) é marcador de gravidade da disfunção autonômica. Os efeitos do treinamento físico sobre índices de VFC na miocardiopatia chagásica (MPC) não são bem estabelecidos. Objetivo: Avaliar as mudanças nestes índices em resposta ao treinamento físico na MPC. Métodos: Pacientes com MPC e disfunção do ventrículo esquerdo (VE), fisicamente inativos, foram aleatorizados para os grupos intervenção (GI, N = 18) e controle (GC, N = 19). O GI participou de um programa de exercícios de 12 semanas, três sessões/semana. Resultados: A idade média foi de 49,5 ± 8 anos, 59% homens, FEVE de 36,3 ± 7,8%. Índices basais de VFC foram similares. Do basal ao seguimento, observamos no GI aumento da potência total (TP): 1.653 (IQ 625 - 3.418) para 2.794 (1.617 - 4.452) ms, p = 0,02) e potência de frequência muito baixa: 586 (290 - 1.565) para 815 (610 - 1.425) ms, p = 0,047), mas não no GC. A variação (pós/pré) dos índices de VFC foi similar: SDNN 11,5 ± 30,0 vs. 3,7 ± 25, 1 ms, p = 0,10; rMSSD 2 (6 - 17) vs. 1 (21 - 9) ms, p = 0,43; TP 943 (731 - 3.130) vs. 1.780 (921 - 2.743) Hz, p = 0,46 e potência de frequência baixa (LFP) 1,0 (150 - 197) vs. 60 (111 - 146) Hz, p = 0,85, exceto pela potência de alta frequência, que teve tendência a aumento no GI: 42 (133 - 92) vs. 79 (61 - 328) Hz, p = 0,08). Conclusão: Na população estudada, a variação dos índices de VFC foi similar entre os grupos ativo e inativo. A melhora clínica com o treinamento físico parece ser independente de marcadores de disfunção autonômica na MPC. .